• Clinical and Experimental Pediatrics
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• v.63 no.2
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• pp.56-62
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• 2020

Background: Red blood cell (RBC) transfusion improves cardiorespiratory status of preterm infants by increasing circulating hemoglobin, improving tissue oxygenation, and reducing cardiac output. However, RBC transfusion itself has also been suggested to negatively affect short-term outcomes such as intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) in premature infants. Purpose: This study aimed to analyze the relationship between RBC transfusion and short-term outcomes in very low birth weight (VLBW) infants (birth weight, <1,500 g). Methods: We retrospectively reviewed the medical records of VLBW infants admitted to the Soonchunhyang University Bucheon Hospital between October 2010 and December 2017. Infants who died during hospitalization were excluded. The infants were divided into 2 groups according to RBC transfusion status. We investigated the relationship between RBC transfusion and short-term outcomes including BPD, ROP, NEC, and IVH. Results: Of the 250 enrolled VLBW infants, 109 (43.6%) underwent transfusion. Univariate analysis revealed that all short-term outcomes except early-onset sepsis and patent ductus arteriosus were associated with RBC transfusion. In multivariate analysis adjusted for gestational age, birth weight and Apgar score at 1 minute, RBC transfusion was significantly correlated with BPD (odds ratio [OR], 5.42; P<0.001) and NEC (OR, 3.40; P= 0.009). Conclusion: RBC transfusion is significantly associated with adverse clinical outcomes such as NEC and BPD in VLBW infants. Careful consideration of the patient's clinical condition and appropriate guidelines is required before administration of RBC transfusions.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.17 no.3
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• pp.162-169
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• 2014

Purpose: To study temporal pattern of serum liver enzymes levels in newborns with hepatic injury associated with birth asphyxia (BA). Methods: Singleton term newborns with BA and ${\leq}72$ hours of age admitted to neonatal intensive care unit were prospectively enrolled. Term newborns with physiological jaundice and without BA were studied as controls. Serum liver enzymes were measured at <24 hours, 24-72 hours, and at 6-12 days of age for cases and at 1-6 days of age for controls. BA was defined by 1 minute Apgar score <7 or delayed or absent cry with hypoxic ischemic encephalopathy. BA-associated liver injury was defined as serum alanine aminotransferase (ALT) elevation beyond +2 standard deviation (ALT > +2 SD) above the mean of control subjects at any of the three time points. Results: Sixty controls and 62 cases were enrolled. Thirty-five cases (56%) developed BA-associated liver injury (ALT>81 IU/L). They had higher serum levels of ALT, aspartate aminotransferase, lactate dehydrogenase than the control infants, with peak at 24-72 hours. In controls, serum liver enzyme levels were significantly higher in appropriate-for-date (AFD) babies than small-for-date (SFD) babies. Serum enzyme pattern and extent of elevation were comparable between SFD and AFD babies. Degree of serum liver enzyme elevation had no relationship with severity of hypoxic encephalopathy. Conclusion: Serum liver enzyme elevation is common in BA; it peaks at 24-72 hours followed by a sharp decline by 6-12 days of age. Pattern and extent of enzyme elevation are comparable between SFD and AFD babies.

• Clinical and Experimental Pediatrics
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• v.59 no.4
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• pp.165-173
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• 2016

Purpose: To identify the effects of modified parenteral nutrition (PN) and enteral nutrition (EN) regimens on the growth of very low birth weight (VLBW) infants. Methods: The study included VLBW infants weighing <1,500 g, admitted to Chungnam National University Hospital between October 2010 and April 2014, who were alive at the time of discharge. Subjects were divided according to 3 periods: period 1 (n=37); prior to the PN and EN regimen being modified, period 2 (n=50); following the PN-only regimen modification, period 3 (n=37); following both PN and EN regimen modification. The modified PN regimen provided 3 g/kg/day of protein and 1 g/kg/day of lipid on the first day of life. The modified EN regimen provided 3.5-4.5 g/kg/day of protein and 150 kcal/kg/day of energy. We investigated growth rate, anthropometric measurements at 40 weeks postconceptional age (PCA) and the incidence of extrauterine growth restriction (EUGR) at 40 weeks PCA. Results: Across the 3 periods, clinical characteristics, including gestational age, anthropometric measurements at birth, multiple births, sex, Apgar score, surfactant use and PDA treatment, were similar. Growth rates for weight and height, from time of full enteral feeding to 40 weeks PCA, were higher in period 3. Anthropometric measurements at 40 weeks PCA were greatest in period 3. Incidence of weight, height and head circumference EUGR at 40 weeks PCA decreased in period 3. Conclusion: Beginning PN earlier, with a greater supply of protein and energy during PN and EN, is advantageous for postnatal growth in VLBW infants.

• Clinical and Experimental Pediatrics
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• v.57 no.4
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• pp.171-177
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• 2014

Purpose: Eosinophilia is common in premature infants, and its incidence increases with a shorter gestation period. We investigated the clinical significance of eosinophilia in premature infants born at <34 weeks gestation. Methods: We analyzed the medical records of premature infants born at <34 weeks gestation who were admitted to the neonatal intensive care unit at Ewha Womans University Mokdong Hospital between January 2003 and September 2010. Eosinophilia was defined as an eosinophil percentage of >3% of the total leukocytes. Perinatal parameters and clinical parameters were also analyzed. Results: Of the 261 infants born at <34 weeks gestation, 22.4% demonstrated eosinophilia at birth. The eosinophil percentage peaked in the fourth postnatal week at 7.5%. The incidence of severe eosinophilia increased after birth up to the fourth postnatal week when 8.8% of all patients had severe eosinophilia. Severity of eosinophilia was positively correlated with a lower gestational age, birth weight, and Apgar score. Respiratory distress syndrome, bronchopulmonary dysplasia, nephrocalcinosis, intraventricular hemorrhage, and sepsis were associated with a higher eosinophil percentage. The eosinophil percentage was significantly higher in infants with bronchopulmonary dysplasia from the first postnatal week and the percentage was the highest in the fourth postnatal week, with the maximal difference being 4.1% (P<0.001). Conclusion: Eosinophilia is common in premature infants and reaches peak incidence and severity in the fourth postnatal week. The eosinophil percentage was significantly higher in bronchopulmonary dysplasia patients from the first postnatal week. Severe eosinophilia was significantly associated with the incidence of bronchopulmonary dysplasia even after adjusting for other variables.

• Korean Journal of Community Nutrition
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• v.9 no.4
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• pp.483-490
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• 2004

Elevated maternal plasma homocysteine concentrations have been associated with adverse pregnancy outcomes, including birth defects, low birth weight, preeclampsia, spontaneous abortion, placental abruption, and other maternal or fetal complications. The purpose of this study was to assess the maternal plasma homocysteine level during pregnancy and to investigate the relationship between the plasma homocysteine concentrations and pregnancy outcomes. Venous blood samples were drawn from 82 pregnant women who were grouped with gestational age, 1st trimester (n = 26), 2nd trimester (n = 27) and 3rd trimester (n = 29). The concentration of plasma homocysteine was analyzed by HPLC, and pregnancy outcomes including gestational length, maternal weight gain, infant birth weight, and Apgar score were collected with the medical records of the pregnant women. The levels of plasma homocysteine of the pregnant women at the 1st, 2nd, and 3rd trimester were 5.7 $$\pm$ 3.7\mu㏖/L,\;5.6 \pm4.1\mu㏖/L\; and\; 7.0\pm 4.5\mu㏖/L$, respectively, which had not showed any significant difference. The result of this study showed that in case of the pregnant women at the 1st trimester, the maternal plasma homocysteine level of the pregnant women whose gestational length was less than 38 weeks was significantly high (p < 0.01) compared to that of the pregnants whose gestational length was more than 38 weeks. And also, the level of homocysteine of the pregnant women at the 2nd trimester was significantly low when the maternal weight gain was high (p < 0.05). These findings suggest that maternal plasma homocysteine level at early stage of gestation will be a predicter of gestational length and maternal weight gain.

• Journal of Korean Academy of Nursing
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• v.29 no.1
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• pp.174-182
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• 1999

The purpose of this study was to contribute to neonatal nursing and maternal nursing to reduce parental role stress in mothers of preform babies and to improve perception of the newborn to by the parents. Data were collected through self-report questionnaires which were consisted of a parental role stress scale and a neonatal perception inventory. The subjects were 100 mothers of fullterm babies and 50 mothers of preform babies, all in the early postpartum stage and admitted to three hospitals in the Kyoung-In area between November 8, 1997 and May 30, 1998. The data were analyzed by a SPSS program and the results are as follows ; 1. There were no significantly differences in the means for parental role stress between mothers of fullterm babies and preform babies. The mean for perception of the newborn was significantly lower in mothers of preform babies than in mothers of fullterm babies. 2. In mothers of preform babies, the level of parental role stress was correlated to the one minute Apgar score. The level of perception of the newborn was correlated to gestational age and birth weight. 3. The mothers of preform babies whose education level was above graduation from college had lower parental role stress than those who had a lowes level of education. The mothers who had experienced cesarean section hd higher parental role stress than those who gave birth to their baby prematurely. The above findings indicate that mothers of preform babies had lower perception of the newborn than mothers of fullterm babies. Therefore, nursing intervention should be provided for mothers of preform babies to manage parental role stress and improve perception of the newborn.

• Child Health Nursing Research
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• v.5 no.3
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• pp.250-261
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• 1999

This study has been conducted on the nonequivalent control group Pretest-posttest design in quasi experimental basis and newly born premature infants from intensive care unit of G Medical University Hospital in Inchon Metropolitan were selected in two groups of 21 infants each. The first group for experimental and the other for control. Data has been collected form October 30, 1997 to August 29, 1998. For the experimental group tactile and kinesthetic stimulation was applied 2 times a day for 10 days(10:00～ll:00 hours in the morning and 17:00～18:00 in the afternoon). As, a weight weighing instrument, electronic indicator scale(Cas Co. korea) was used. Collected data were analyzed with the SAS program using x²-test, student t-test, repeated measures ANOVA, Pearson correlated coefficient and Stepwise multiple regression. The result were as follow. 1. As for the daily weight gain, the experimental group showed first change in weight and this group also showed higher weight in the average weight than the control group. Statistically, however. there was no significant factor between the two groups. 2. In the correlation between general characteristics and weight gain, gestation Period. apgar score, admission Period before study, N.P.O. period after birth, recovery Period to birth weight showed statistical significance negative correlation with weight gam in the experimental group than control group. 3. In the factor with affected the weight gain by general characteristics showed recovery period to birth weight and head circumference in the experimental group, control group showed recovery period to birth weight, N. P. O. period after birth. admission period before study, feeding amount, weight of study. In conclusion. the sensory stimulation in this study showed a Positive aspect through there was no statistical significance in the weight gam. Tn the correlation of general characteristics and weight gam showed statistical significance negative correlation The main factor which affected the weight gain by general characteristics showed recover period to birth weight.

• Journal of Nutrition and Health
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• v.32 no.5
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• pp.592-597
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• 1999

The purpose of this study were to determine the folate status of pregnant women living in kwangju, Korea and to assess the relationships between folate status and pregnancy outcome. Eighty-one women took part in the study: 26 in their first trimester of pregnancy, 23 in the second, and 32 in the final trimester. The folate intake data both from their diets and supplementasage was obtained using a 24-hour recall method and by measuring the use of supplements. Folate levels of serum and erythrocytes were determined by a microbiological assay using Lactovacillus casei(ATTC 7469) as the test organism. A series of determinations for pregnancy outcome was conducted, including birth weight, length, Apgar score at 5 min after birth, and gestational period. The dietary folate intake in each trimester was 118$\pm$85, 148$\pm$117, and 137$\pm$69ug/d, respectively. All levels were far below the Korean recommended diet allowances(RDA)for folate. Eighty-four percent of the subjects consumed supplemental folate after the 20th week of pregnancy until delivery. the supplemental folate intakes in the second and third trimester were 651$\pm$142 and 688$\pm$150ug/d, respectively. Therefore, the women who took folate supplements consumed more folate than the RDA. Serum folate levels for each trimester were 9.0$\pm$3.8, 11.4$\pm$6.0, and 16.3$\pm$11.0ng/ml respectively, greadually increasing as the pregnancy progressed; the serum folate level in the third trimester was significantly higher(p<0.05) than that in first trimester. The erythrocyte folate concentrations in each trimester were recorded as 369.8$\pm$108.8, 396.2$\pm$107.5, and 420$\pm$7 162.6ng/ml respectively. There was no significant differences among the erythrocyte folate concentrations unlike the serum folate levels. There was no significant difference among the erythrocyte folate concentrations unlike the serum folate levels. There was no signifcant correlation between trimester to be important in maintaining adequate folate status, however these results imply that the serum and erythrocyte folate levels were adequate to support the growth of the fetus.

• Women's Health Nursing
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• v.24 no.1
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• pp.49-57
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• 2018

Purpose: Postpartum fatigue can impact maternal well-being and has been associated with levels of perceived self-care. This study aimed to examine the relationship among fatigue, depressive mood, self-care agency, and self-care action among postpartum women in Bangladesh. Methods: A descriptive cross sectional survey was done with 124 first-time mothers from two tertiary hospitals in Dhaka, Bangladesh. The Modified Fatigue Symptoms checklist, Denyes' Self Care Instrument, the Edinburgh Postnatal Depression Scale, and items on sociodemographic and delivery-related characteristics, were used in Bengali via translation and back-translation process. Results: High fatigue levels were found in 18.5% (n=23) and 73.4% had possible depression (n=91). There was a significant negative relationship between fatigue and self-care agency (r=-.31, p<.001), and self-care action (r=-.21, p<.05). Fatigue differed by level of self-care agency (t=4.06, p<.001), self-care action (t=2.36, p=.023), newborn's APGAR score (t=-2.93, p=.004), parental preparation class participation (F=15.53, p<.001), and postpartum depressive mood (t=-4.64, p<.001). Conclusion: Findings suggest that high level of self-care efficacy and behaviors can contribute to fatigue management, and highlight the need for practical interventions to better prepare mothers for postpartum self-care, which may, in turn, alleviate postpartum fatigue.

• Perinatology
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• v.29 no.4
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• pp.147-152
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• 2018

Objective: This study examines whether maternal group B Streptococcus (Streptococcus agalactiae, GBS) infection was associated with preterm births and premature neonatal outcomes. Methods: Maternal and neonatal outcomes were examined among singleton pregnant women with preterm birth (from $24^{+0}weeks$ to $36^{+6}weeks$) who were tested for GBS (n=203) during the pregnancy. Data were collected retrospectively from the medical records of women who delivered at our hospital from January 2015 to February 2017. We compared obstetrical factors (causes of preterm birth) and neonatal (gestational age at delivery, birth weight, Apgar score 1 min/5 min, hospitalization period, duration of mechanical ventilation, neonatal C-reactive protein within three days, and other complication [respiratory distress syndrome, neonatal deaths]) outcomes between GBS-infected and non-infected pregnant women. Results: There were 203 singleton pregnant women included in the study, 25 of whom were confirmed to have a GBS infection during the pregnancy. There was no difference in neonatal outcomes by GBS status. Preterm premature rupture of membranes (pPROM), as an obstetric factor, was associated with GBS infection (P=0.022). GBS infection raised the risk of pPROM by 3.6 times (odds ratio 3.648, 95% confidence interval 1.476-9.016, P=0.005). Conclusion: GBS infection in preterm birth was associated with pPROM but did not result in adverse neonatal outcomes. Continuous attention and evaluation of GBS infection, a major cause of neonatal sepsis and pneumonia, are needed.